The Ear

Question 1

What is otalgia?

Answer 1

Ear pain

Question 2

Which bone of the skull houses the ear?

Answer 2

Temporal bone

Question 3

What does the external ear contain?

Answer 3

Pinna, external auditory meatus and lat. surface tympanic membrane

Question 4

What is the function of the external ear?

Answer 4

Collect, transmit and focus sounds waves onto tympanic membrane

Question 5

What is Ramsay hunt syndrome?

Answer 5

Shingles of the facial nerve- affects sensory ganglion causing facial nerve palsy and eye drop

Question 6

What is a pinna haematoma? How do you treat? What can happen if not?

Answer 6

Secondary to blunt trauma to the pinna. Accumulation of blood between cartilage and perichondrium- avascular cartilage deprived of blood supply and pressure necrosis of the tissue. Prompt drainage for reapposition of the two layers, prevent re-accumulation of get CAULIFLOWER EAR-> fibrosis and new asymmetrical cartilage

Question 7

How do you examine EAM/ear canal?

Answer 7

Pull ear up and back (sigmoid shaped), skin lined

Question 8

What is the EAM made of?

Answer 8

Outer 1/3 cartilage, inner 2/3 bony

Question 9

What is the function of hairs and wax in the ear canal?

Answer 9

Prevents objects entering deep, aids desquamation and skin migration out of canal so epithelia renews, wax removed too

Question 10

How long is the ear canal?

Answer 10

2.5 cm

Question 11

What is Ottitis externa?

Answer 11

Infection and inflam of ear canal e.g swimmers ear. V painful. Cant really see TM, may get discharge

Question 12

What does a healthy TM look like?

Answer 12

Pearly, translucent fibrous membrane

Question 13

What 2 abnormalities might you seen on a TM?

Answer 13

Perforation, budging secondary to ottitis media

Question 14

What is the middle ear made up of? Which bone is it in?

Answer 14

Ossicles- malleus, incus, stapes (MIS).
Air filled cavity between TM and inner ear.
Petrous part of the temporal bone

Question 15

What do the ossicles do?

Answer 15

Amplify vibrations from TM to cochlea via oval window

Question 16

What is the function of the ET?

Answer 16

Equilibriates pressure in middle ear with that of the atmosphere. Ventilated and drains mucus too

Question 17

What is ottitis media with effusion? How does it affect hearing? How do you treat?

Answer 17

“Glue ear”- NOT AN INFECTION- a build up of negative pressure in the middle ear due to ET dysfunction. Can predispose to infection.
Mobility of TM and ossicles decreased.
Resolve or grommets.

Question 18

What does glue ear look like?

Answer 18

Retracted and TM looks straw like

Question 19

What is ottitis media? Who is it more common in? How does it present? What does it look like?

Answer 19

Acute middle ear infection.
More common in children- tug at ear, temp.
Red and bulging

Question 20

Why are kids more susceptible to middle ear infections?

Answer 20

ET shorter and more horizontal than adults, easier passage of infection from nasopharynx to middle ear. Tube can block more easily compromising drainage and Ventilation

Question 21

Name 4 complications of ottitis media?

Answer 21

TM perforation, facial nerve involvement, mastoiditis, IC- meningitis, sigmoid sinus thrombosis, brain abscess

Question 22

What is the important anatomical relationship of the TC, where can infection spread to?

Answer 22

Relationship with mastoid bone, can spread to mastoid air cells

Question 23

What is mastoiditis? Signs and symptoms? Treat?

Answer 23

Mastoid air cells (comm with middle ear) to help equilibrate pressure in middle ear infected. Ear pushed forward, red and swollen behind. Urgent hospital referral.

Question 24

How may the facial nerve be involved in middle ear pathology?

Answer 24

Chords tympani branch esp runs through middle ear cavity

Question 25

What is cholesteatoma? What causes it>

Answer 25

Painless ear discharge (otorrhea). Usually secondary to chronic/ reoccuring ear infection/ blocked ET. Skin cells get trapped, collect and grow in pocket, not malignant, expands and erodes eg ossicles, chochlea, mastoid

Question 26

What do you seen when looking at the TM in Cholesteatoma?

Answer 26

Ear drum sucked in (-ve pressure) and crusting in the attic

Question 27

What is the inner ear made up of? What do the parts do?

Answer 27

``` Vestibular apparatus (3 semicircular canals) and cochlear. Vestibular apparatus- Maintains sense of balance an position. Cochlear converts vibrations -> a.p's -> sound perception. ```

Question 28

What is the cochlea? How do it allow hearing? What type of hearing loss is seen if affected?

Answer 28

Fluid filled organ of hearing. Movement at oval window (when stapes vibrates) causes movement of fluid in cochlea. Fluid waves move SS cells in cochlea which fir a.p's. Sensorineural

Question 29

How do we hear?

Answer 29

1. Stapes vibrates at oval window. 2. Cochlear fluid moves, sensed by nerve cells in cochlear duct (spiral organ of Corti). 3. Movement of R's on organ -> a.p in CNXIII -> brain

Question 30

What does the vestibular apparatus contain? What does it do?

Answer 30

Semicircular canals, saccule, utricle. | Fluid filled series of channels and sacs that respond to position, rotation and maintain our balance

Question 31

What 3 pathologies can be caused if the vestibular apparatus isnt working>

Answer 31

Vertigo (room spinning), Menniere's disease, benign paroxysmal positional vertigo (vertigo when change head position)

Question 32

What is an acoustic neuroma? What are the symptoms?

Answer 32

Rare, benign tumour of schwann cells of vestibulocochear nerve. Unilateral hearing loss, tinnitus, balance problems.

Question 33

What is the link between ear infections and adenoids? Treatment?

Answer 33

Adenoids in nasopharynx, may block opening of ET is large. Impede ventilation and drainage of middle ear -> glue ear and infection. Remove them.

Question 34

What is the link between sore throats and ear pain?

Answer 34

Infection spread to middle ear via ET (ottitis media). Shared sensory innervation of oropharynx with inner TM and middle ear (CN9).

Question 35

What is Rinne's test? What is normal? How does sensorineural and conductive hearing los present?

Answer 35

Tuning fork behind ear on mastoid process, when cant hear put in front. Normal= +ve- AC>BC Sensorineural= AC>BC Conductive= BC>AC

Question 36

What is Webber's test? What is normal? How does sensorineural and conductive hearing los present?

Answer 36

Tuning fork on head- should not be heard or be hear equally. Conductive= towards effected ear louder Sensorineural= away from affected ear- quieter